Insurance-policy form



May 6, 1930.

V. F. PoLLAK INSURANCE POLIGY FORM Filed Aug. 9.A 1928 Annul rw-mas Y.: im

www IMI-rrd Minid ANHdNOJ JDNUHHSN :will n" lla H83/ 4Patentedl May 6;,19304 p Y y vlc'ronr;` `14oLLA'iigfoF sAiI remorse@CAILFORNIAV;

n INSURANCE-renferment A Application alea august 9515528. serial' n1298485.

V`My invention relates to improvements in insurance policyforins wherein as'heetfoldj able along a transverse centerline .and iinfront and back portions of the policyandV Y held attached to said front and backportions:

`unt-il the policy is to befilled out.

The primary object of my invention is to I provide lan improved insurance policy form.

Anotherobject is to` provide, an improved forrn-wherein triplicate v.sheets are .formed vrfrom a single sheet as parts of an insurance` policy, saidsheets being folded into-accurate-V .lledout y n Y A furtherobject-is to-provide anV improved form which will facilitatel printing and numbering of policies and which will-insure conformity-as to the numbering of thetriplicate sheets of the policy. VAnother object is to provide-an improved policy which will facilitate thegathering of the Vprinted sheets, and which will insure against the loss or inisplacingof any of the sheets` of; al ;po licy.{ j Y v A still 'further object is to provide animproved policy which will facilitate the insertion of carbon paper and the lillingout of the policy and the daily report and agents i record sheets forming a part thereof.

means of the improved device disclosed inthe cation wherein like characters of reference are used to designate similarparts through-i5 with the daily report and agents record sheets i Y folded against the body of the policy; and

ly registering relation andbeing held .to-I.. gether until suchtirne asthe policy is to be A forat'ed line of fold 7 whereby thesheets` drawings forniinga partofithe present appliy afprintedl blank` manner 1in whichthesheets register. v Y

, Referring tothe dra-wings, yiny improved insurancel forniv Yci'iniprisesa faceY portionjl;v f aback portion 2,'adailytl report sheet 3, and an"a'gents-recordsheet-e. v The several por? tions of the Vpolicy `are imprinted upon a sin-r` gle-blank asindicated `in Fig. 1 ofthe draws.

ings, the lfront and back portions l and 2' `con,v

,stituting the main body ofy the-policy andthe f SheetsBB-and beingfornied as an extension"V line in '.Fig. vl. The extension upon :thesidc of the bodyis perforated vas atk 5 along va prolongation of the transverse centerline ofthe body ofthe policy,to form thesheets 3: and

4. The sheet is'severed as at 6 from't-hev side of the faceportion l, `and the sheet l is attached to the back portion 2 along a -perf) and 4 Inay be folded againstithe baclcof Vthe l portion as *showny in' Fig. 2 of the drawings.y j f; Y

The daily reportk sheet is imprintedy upon its baclcas appearingv in Fig. l Aofthe drawings with a forrn corresponding to the forni Lprinted upony the face 1 ofthe policy, andthe agents record sheett is imprinted with a cory responding forinprinted upon the upper side of the sheet as shown in Fig. 1 but readable from thel opposite' directiorrf The forinsare Y- incorresponding relation to the'topand sides willfeXact-ly` register. with theV form 'of the Vface 'lofithe-policy, and when the policy VLis folded along its transversecenterline, to :theno'r1nalgrelation-jshowninFigr3 ofthe f drawings, 4the faceportion l'and sheet B will Y .v ,registerexactly `with'the sheet t` whichis at-l tached along theperforated line fof fold 7,;

registered superimposed relation, yand all facedinthe same direction. u x

4'Ihefblanl from which the policy is formed is cut tofpiovide the vstandard ,policy size for u50 Fig. 3 is a broken plan view of the folded jthefrontand'backportions policy, partsbeingfbrokenaway to showthe l l `upon o1iesideof said body. The `rnainzbody is arranged-tube folded"l along' autransverse Vcenterline as indicated by thel clot 'and dash of the.. sheets softhatwhen thesheetsandv 5 @are folded against ,the back of the policy body as'shown in -Figl21 the forinof sheet 3 I accomplish theseandrother objects by I ktherebyholdingthethreefornisinaccurately 95 i A sheets 3 and4 are inade of standard letter size, notches being cut in the corners to provide the proper lengthfoi the sheets 3 and4. T he i policy contract, blank forms,V and other` sub'- ject inatter Vis imprinted upon the body portions l and 2, While the corresponding forms and other. subject- -inatterfis imprinted upon 1 the sheets-3-aiid4 as in the comino-n practice, the printing however` being accoinplishediby printing the body; andthe sheets. 3 and 4 to-V gether, thereby reducing the number of runs 5 which must be inade to print Vtheentire policy.

'i The policy and the sheets 3 and 4 are all numbered to correspondgiandpas i-t is essen,-l tial thatfan accurate record be kept of all policies, it isfhiglily important that the nurnbering ,of the.'sheets eonitornes and that all u jsheetsare present when fthe poflicylis'flilledA out:` lVhe-re'the slieets'arej printed separate ly; as in they common-practice heretofore, the .printed sheetslniust-bekgathered andstuled.

If one sheet f is gathered 5 incorrectly,V as by i tu lce

`entryspa'ces;` and aj lateral extensiony `formed v and all lthe sheets areheld inattachnaent with eachother so that a' siinpl'e folding process takes thefplace of f the usual Ygathering and stu'hng ot'tl'iesheetsf,` and no mi's'talpe'can possibly be made# FurthermoreL-the sheets'are held together so that-no sheet can b e lost.

Vhen the policy isfolded-to nornial relation* as "shown iin Figa, 3 of the drawings, Vthe sheets Sand 4are bound together along their V upper edges Within the fold of the'body' of the policy, and `at the's'anietimeVthe sheets vare held attached to the back of the policy. This insures that the fornis printed upon theface of thepolicy Aandupon-'sheets and 4 will be heldin accurately registered relation.

The ends efthe yface portieril 1 ran'dsheet 3 are free so? that sheets of carbonfpaper maybef inserted between the sheets Without separating -anyof the slieet'sgalong tht perforated lines of fold, therebyfacilitating the inserting of'canbon paperV and permitting theforms Yto be filled out in.theftriplicate-atfone operation.;

E'Having thus described iny invention, what l desire tosecuie by Letnature.

y foini comprising a body portiqn l'iav-ingalii-ie oli-fold coincident ingredgeof the facejporti'on and having a perforated line of fold coinciding, with the 1,757,094 i' g Y' transverse ccnterlnepof the extension and orining a continuation of the transverse centerline of the body; and entry forms printed upon the extension upon opposite faces there- ,of having' entrylspaces disposed and des ignated "similarlyl to the entry spaces ofthe f policy face andbeing oldable to matchingl relation*toeaeho'ther/andlto the policy face `for duplicating"entries by ineans of inter- Vposedcarboii' material.

2. Anii'isui'a'nce policy form comprising a Y bodyiportion l having a line of fold coincident with yits transverse center line to orin face and vback portions-"ofthe policy and printed with suitable subject; matterfincludingf an V'eilitry vkformipr-inted upon the face. to torni entry spaces; a 'lateral extensionlforined upon one -sideoat the body and -j oined-thereto along n a?perforatedzlineolitold entending along one side of the backportienand:de nilngthe lon-r gitudinal centerline oztthe body and? exten- ','s ion`,` said extension being severed troni' the inatchingedgeof the-facelpo'rtion ValongI said 'L longitudinal centerline-andliavingla perforatedY line' ofi told vcoincidingY with the'.v transverse centerline ofthelextensrionsy and or'rni ing a continuation ofx the transverse centerline of `thefbody5` v the extension being shorter tliai-'i-fthe body and -for'niing duplicate record sheets eldable intofmatching relation between-fthe face and back loit-tl'i'e; body entry VVforms printed'uponl the record sheets in' oppositely disposed relationto/k thelperlforated Aline of ytold`V jioini'ngsaidf sheets and upon'opposite facesfof the exteiisionpsaid forms Ahav-l ing entryspaces disposed and designated sinn-V i ilarly to the entryy spaces of 'the policyrface and 'be'iiig=movedinto registering relation with ,eachother and With the policy'face when the sheets are folded into'mzptehing relation policyorlduplicating `entries inade kWithin the entry spaces of the I I K policyface-bynieansi1 of carbon vifnateri-al`v Y fbet-WeenQ 'thel face and Vl'amael;portions ofV the K i I In Witness whereof7 hereunto set inyfg'sijg-v with' its transversecenterlineto ferne face f and'back portions of the policy andzprinted l with suitable subject f matter iincluding an esay-fernrprimea upon than@ to provide 1 u on one side of the body andjoi'nedthereto i wie at perfected; linaire@'extending elongate .Sieotlie beest-@nicsci-tle'bdy, Y Y fsa-idfeXtensionlbeingseveredfroin` the match- 

